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Article
November 21, 1990

Risk Factors for Measles in a Previously Vaccinated Population and Cost-effectiveness of Revaccination Strategies

Author Affiliations

From The Bureau of Community Health and Prevention, Wisconsin Division of Health (Drs Mast and Davis and Mssrs Berg and Hanrahan); and the Departments of Pediatrics and Preventive Medicine, University of Wisconsin School of Medicine (Drs Mast and Davis), Madison; the Divisions of Surveillance and Epidemiology (Dr Wassell) and Field Services (Dr Mast), Epidemiology Program Office, Centers for Disease Control, Atlanta, Ga. Dr Mast is now with the Division of Viral and Rickettsial Diseases, Center for Infectious Diseases, Centers for Disease Control.

From The Bureau of Community Health and Prevention, Wisconsin Division of Health (Drs Mast and Davis and Mssrs Berg and Hanrahan); and the Departments of Pediatrics and Preventive Medicine, University of Wisconsin School of Medicine (Drs Mast and Davis), Madison; the Divisions of Surveillance and Epidemiology (Dr Wassell) and Field Services (Dr Mast), Epidemiology Program Office, Centers for Disease Control, Atlanta, Ga. Dr Mast is now with the Division of Viral and Rickettsial Diseases, Center for Infectious Diseases, Centers for Disease Control.

JAMA. 1990;264(19):2529-2533. doi:10.1001/jama.1990.03450190061029
Abstract

Using data from a large measles outbreak that occurred in Dane County (Wisconsin) in 1986, we conducted a case-control study to evaluate risk factors for vaccine failure and assessed the cost-effectiveness of school-based revaccination strategies. Vaccination before a change in the measles vaccine stabilizer in 1979 (odds ratio, 5.5; 95% confidence interval, 1.05 to 28.9) and vaccination before age 15 months (odds ratio, 13.9; 95% confidence interval, 5.9 to 32.6) were identified as risk factors. Revaccination strategies for all students ($3444 per case prevented), students vaccinated before 1980 ($3166 per case prevented), and students vaccinated before age 15 months($2546 per case prevented) were evaluated, assuming use of measles-mumps-rubella vaccine after the initial case was detected in a school. However, a large proportion of cases (43% to 53%) may not have been preventable using these strategies. Therefore, revaccination in all schools assessed to be at risk for measles may be necessary to prevent large outbreaks until a two-dose vaccination schedule is fully implemented.

(JAMA. 1990;264:2529-2533)

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